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Creating a Successful Operational Model for PDGM Success
Date: Wednesday, Sep. 25, 2019
Time: 12 p.m. ET
Home health providers seeking PDGM success will want to install an operational management model that addresses specific value changes. PDGM reforms outline home health care programs that must be managed in an ongoing manner, like acute care episodes. By employing a utilization review-based care production and delivery model, agencies can bring clinical control in-house to manage for PDGM success. Regarding clinical episode management under PDGM, the balance of control between supervisors and clinical delivery staff shifts significantly towards clinical managers.
By adopting a utilization review-based operational model, progressive providers can address all elements of PDGM and subsequent reforms including PCR, VBPM expansion, and Post-Acute PPS (bundling all acute care discharge diagnoses). In addition, utilization review allows for efficient Intake, plan of care development, scheduling, (and productivity), CMS-qualified audit-proof programming, and 4+/5 Star Ratings. Case studies will demonstrate how agencies who currently employ a utilization review-based care management model will post increased margins under PDGM. Don’t miss this exciting presentation for your introduction to the care path to PDGM success!
Participants will gain insight into how to manage PDGM to success by participating in this program.
Presenter: Arnie Cisneros, PT
President, Home Health Strategic Management
As President of Home Health Strategic Management, Arnie has provided clinical services, program development, and management consultation in the areas of post-acute care, sports medicine, and episodic programming for more than 30 years.
He is renowned for his adaptation of traditional care philosophies to address current and future healthcare reform initiatives. Having delivered care across an evolving care continuum during the PPS era, he is able to position HHSM as the leading post-acute consulting firm in terms of rewiring care for quality clinical outcomes. As a result, HHSM has been selected as post-acute consultants for multiple Pioneer ACOs, including the awarding and development of a CMS Innovation Center Bundling Pilot Demonstration Project in conjunction with the Detroit Medical Center. The subsequent bundling program served as the basis of the first mandatory CMS Alternative Payment Model (APM), Comprehensive Care for Joint Replacements (CJR). HHSM subsequently became post-acute clinical consultants for the DMC MI Pioneer ACO, managing all DMC discharges for sub-acute and home health services.
HHSM is a leader in the establishment of a utilization review (UR) model for home health care development and delivery. The HHSM UR Model, SURCH – Service Utilization Review for Care in the Home, was named the 2016 VNAA Innovative Home Health Care Model for its ability to successfully address and program care in terms of the quality requirements. The SURCH model routinely increases care-mix and HHRG levels >25%, decreases nursing staffing costs while improving productivity, manages care on an in-episode basis, and delivers 4.5 – 5 Star Ratings; all in an audit-proof manner.
